Recently a British woman bitten by a puppy on a visit to India has died in London, but there have been very few deaths in recent years, all from dog bites abroad ( and a bat-handler in Scotland ). The UK is essentially rabies free, because of strict quarantine laws.
Almost always fatal in humans - at least 50,000 deaths worldwide ( an underestimate because rabies may not be notifiable ), and 200 - 300 in the Philippines ( out of 200,000 300,000 dog bites) each year. No effective treatment. Traditional healers ( tandok placing a deer horn over the wound ) have NO place.
In the Philippines - as elsewhere - dogs ( asong kalye, or strays / abandoned pets ) are the main source. Transmission from humans is not known.
Rabies viruses enter the body in saliva from a bite, reaching the brain by travelling along a nerve. Incubation - 2 weeks ( or less ) to over a year, depending on where the bite occurred. The old name "hydrophobia" means fear of drinking water because of muscle spasm.
Most visitors dont have rabies immunisation. It's only recommended in certain circumstances such as occupation or limited access to medical treatment. Avoid contact with dogs, cats and other animals whenever possible.
"Pre-exposure prophylaxis" - vaccination for protection - means 3 doses of rabies vaccine, with further booster doses if needed.
"Post-exposure management" - including cleaning and dressing the wound - is EITHER :- 4 or 5 doses given over one month (days 0, 3, 7, 14 and 30), and possibly rabies immunoglobulin (day 0) OR - if already immunised - 2 doses of vaccine, on day 0 and day 3.
Immunisation can be discontinued if it's proved that the individual is not at risk ...but if the dog dies (even if a sample is not available to prove that it had rabies)...then it MUST be completed.
Vaccination is not available on the NHS so you would have to pay at your GP surgery or travel clinic a complete course of 3 would be up to £ 150. Its intradermal ( skin of upper arm ) , not painful, usually with no side effects.
Half of people infected with rabies are children aged younger than 15 years. All of these deaths could have been prevented by postexposure prophylaxis - wound cleaning, active immunisation with a safe rabies vaccine, and passive immunisation with a rabies immunoglobulin. Cost prevents its use in low-income countries - so people die. There is a global shortage of vaccines and immunoglobulin.
Rabies monoclonal antibodies are undergoing clinical trials, so passive immunisation might become more accessible, affordable, and routinely used. That, and an adequate supply of modern tissue-culture vaccines could reduce the burden of this dreadful disease.
Rabies cases dogs and humans - in the Philippines have dropped in the past few years. Since 2007 there has been an anti-rabies law attempting to register and vaccinate dogs, educate the public, provide routine immunisation of school children and high-risk personnel and treat animal bite victims.
Mass vaccination of dogs is the single best way of preventing most human cases. This needs government and vet support, with understanding by the population, especially dog owners. A pilot programme in Bohol has reduced deaths to zero from 10 / year. Many dogs have been registered and vaccinated, more clinics are available for post-bite treatment, and children are educated in school.
The hope is for Philippines to be rabies free by 2020.
http://www.nhs.uk/Conditions/Rabies/...roduction.aspx
